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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
',24-.09
~. ~r::n ~::;y I PERMIT NO.OO. 04-zrl
3. Yellow Applicant . 7. Y
ADDRESS
15000 Green Oaks Trail SE Prior lake
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) Tim & Karen Nissen
(Phone)
952-447-1934
(Address)
15000 Green Oaks Tr Se
APPLICANT
(Name) Ron I s Mechanical Inc
(Phone)
952-445-8585
(Addres~ 12010 Old Brick Yard Road Shakopee
(Address)
(City)
55379
(Zip Code)
(Contact Person)
Linda
APPLICANT SIGNATURE
952-445-8585
DATE
APPLICANT PLEAS COMPLETE BELOW
DNEW CONSTRUCTION REPLACEMENT D ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
TYPE OF SYSTEM
RETURN OPENINGS
INPUT
OUTPUT
HEATING OR POWER PLANT
OWann Air Plants
OGravity
o li'echanical
~ir Conditioning
OVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
into Required Side Yard Setbacks.
Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1% of job cost Residential, Gas Fireplace
$49.50 minimum
$149.50
$64.50
$49.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$49.50
$49.50
Estimated Cost $
dWOO
Building Permit #
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ Y1.q)
$ .50
$-:sJ.OO
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildin!! Official
Date
Paid 50, d2J
Datet. ~ Z ,()
Receipt No.se Z 73
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372